Insruance Questions
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each of the black spaces below before clicking
on it to display the answer.
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| Polices that have a pharmacy benefit do not provide coverage for a selection of prescription medications T or F | True
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| If a policyholder or a covered dependent gets sick, the health plan pays most of the bill. True or False | True
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| Workers compensation cases vary according to? | State Law
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| A remittance advice is also known as an | explanation of benefits
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| The final step in the pharmacy billing cycle is | Collections and problem resolution
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| The balance due on a claim is likely to be paid about how many days after the day of service? | 30-60 days
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| An electronic data interchange may be sent during which step of the pharmacy billing cycle? | Pharmacy Claim Transmital
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| The payer starts internal processing of the claim for payment to the pharmacy during which step of the pharmacy billing cycle? | Calculation of payer claim balance
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| States may not restrict price increases on premiums and other charges to patients True or False | False
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| Pharmacies cannot withhold the information in a patient's medical records unless provding it would be detrimental to the patient's health True or false | True
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| Which of the following is not one of the ways CMS preforms activities to ensure the quality of health care? | Setting prices for prescription drugs and physician visit
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| CMS administers the Medicare and Medicaid programs to more than | 90 Million americans
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| To further regulate the health care industry, states may do all of the following except | Create their own guidelines to replace federal guidelines
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| Pharmacy benefit managers are hired by employers to operate their prescription drug benefit more inexpensively T OR F | True
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| Patients who belong to a preferred provider organization are required to see providers within the network T OR F | Falce
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| What can employees purchase to add coverage such as vision and dental services? | Riders & Options
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| A third-party administrator of prescription drug programs that processes and pay prescription drug claims is called a | Pharmacy benefit manager
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| The federal government pays Medicare claims directly. T OR F | False
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| Everyone who is enrolled in Medicare Part A is automatically enrolled in Medicare Part B. T OR F | False
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| Medicare Part B dose not cover emergency services T OR F | False
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| What is the maximum amount a NonPAR provider could charge a Medicare procedure listed at $200 in the Medicare nonparticipating fee schedule? | $230
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| Medicare has two major parts, one for care given by institutions and the other for services by | Physicians
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| To pay medicare claims, the federal government contracts with insurance organizations known as | Medicare administrative contractors
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| People who are eligible for Social Security benefits are automatically enrolled in | Medicare part A
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Created by:
IceQueen1981
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